Skip to main content
SpringerLink
Log in

Withdrawal time of 8 minutes is associated with higher adenoma detection rates in surveillance colonoscopy after surgery for colorectal cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background & Aims

Although several studies have been conducted on the relation between withdrawal time (WT) and adenoma detection rate (ADR) in the intact colonKim, little is known about the optimal WT needed to increase ADR in the postoperative colon. We investigated the association between WT and ADR in surveillance colonoscopy after colorectal cancer (CRC) surgery.

Methods

We conducted a retrospective cohort study of CRC patients who underwent 1st surveillance colonoscopy after curative colectomy. We excluded patients with incomplete inspection of colon during preoperative colonoscopy, inadequate bowel preparation, and total colectomy or subtotal colectomy. The colonoscopies were performed by 8 board-certified colonoscopists. The receiver operating characteristic curve of the WT revealed an optimal cutoff value of 7.8 min for adenoma detection. We divided the colonoscopists into fast and slow colonoscopists using the 8-min WT as cutoff, and compared the ADR between the two groups.

Results

We analyzed a total of 1341 patients underwent first surveillance colonoscopy after CRC surgery. Mean WTs by 8 colonoscopists during colonoscopy with and without polypectomy were 18.9 ± 13.7 and 8.1 ± 5.6 min, respectively. ADR varied from 29.3 to 50.6% by individual colonoscopists. Slow colonoscopists showed significantly higher ADR than fast colonoscopists (49.1% vs 32.2%, P < 0.001). The mean WT during colonoscopy without polypectomy for each colonoscopist and the detection rate of all neoplasia were positively correlated (Rs = 0.874, P = 0.005).

Conclusion

Because patients who underwent colorectal surgery possess high risk of metachronous CRC and adenoma, sufficient WT (8–10 min) is mandatory, despite short length colon due to surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brenner H, Kloor M, Pox CP (2014) Colorectal cancer. Lancet 383:1490–1502. https://doi.org/10.1016/s0140-6736(13)61649-9

    Article  PubMed  Google Scholar 

  2. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66:683–691. https://doi.org/10.1136/gutjnl-2015-310912

    Article  PubMed  Google Scholar 

  3. Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Robertson DJ, Rex DK (2016) Colonoscopy surveillance after colorectal cancer resection: recommendations of the US multi-society task force on colorectal cancer. Gastroenterology 150:758–768.e711. https://doi.org/10.1053/j.gastro.2016.01.001

    Article  PubMed  Google Scholar 

  4. Rusiecki J, Cifu AS (2017) Colonoscopy surveillance after colorectal cancer resection. JAMA 318:2346–2347. https://doi.org/10.1001/jama.2017.17613

    Article  PubMed  Google Scholar 

  5. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573. https://doi.org/10.1002/cncr.24760

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wanders LK, van Doorn SC, Fockens P, Dekker E (2015) Quality of colonoscopy and advances in detection of colorectal lesions: a current overview. Expert Rev Gastroenterol Hepatol 9:417–430. https://doi.org/10.1586/17474124.2015.972940

    Article  CAS  PubMed  Google Scholar 

  7. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG 2nd, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Gastrointest Endosc 81:31–53. https://doi.org/10.1016/j.gie.2014.07.058

    Article  PubMed  Google Scholar 

  8. Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803. https://doi.org/10.1056/NEJMoa0907667

    Article  CAS  PubMed  Google Scholar 

  9. Corley DA, Levin TR, Doubeni CA (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370:2541. https://doi.org/10.1056/NEJMc1405329

    Article  PubMed  Google Scholar 

  10. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541. https://doi.org/10.1056/NEJMoa055498

    Article  CAS  PubMed  Google Scholar 

  11. Barclay RL, Vicari JJ, Greenlaw RL (2008) Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy. Clin Gastroenterol Hepatol 6:1091–1098. https://doi.org/10.1016/j.cgh.2008.04.018

    Article  PubMed  Google Scholar 

  12. Shaukat A, Rector TS, Church TR, Lederle FA, Kim AS, Rank JM, Allen JI (2015) Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy. Gastroenterology 149:952–957. https://doi.org/10.1053/j.gastro.2015.06.044

    Article  PubMed  Google Scholar 

  13. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR (2012) Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 143:844–857. https://doi.org/10.1053/j.gastro.2012.06.001

    Article  PubMed  Google Scholar 

  14. Lee TJ, Blanks RG, Rees CJ, Wright KC, Nickerson C, Moss SM, Chilton A, Goddard AF, Patnick J, McNally RJ, Rutter MD (2013) Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 45:20–26. https://doi.org/10.1055/s-0032-1325803

    Article  CAS  PubMed  Google Scholar 

  15. Butterly L, Robinson CM, Anderson JC, Weiss JE, Goodrich M, Onega TL, Amos CI, Beach ML (2014) Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 109:417–426. https://doi.org/10.1038/ajg.2013.442

    Article  PubMed  PubMed Central  Google Scholar 

  16. Choe EK, Park KJ, Chung SJ, Moon SH, Ryoo SB, Oh HK (2015) Colonoscopic surveillance after colorectal cancer resection: who needs more intensive follow-up? Digestion 91:142–149. https://doi.org/10.1159/000370308

    Article  PubMed  Google Scholar 

  17. Balleste B, Bessa X, Pinol V, Castellvi-Bel S, Castells A, Alenda C, Paya A, Jover R, Xicola RM, Pons E, Llor X, Cordero C, Fernandez-Banares F, de Castro L, Rene JM, Andreu M, Gastrointestinal Oncology Group of the Spanish Gastroenterological Association (2007) Detection of metachronous neoplasms in colorectal cancer patients: identification of risk factors. Dis Colon Rectum 50:971–980. https://doi.org/10.1007/s10350-007-0237-2

  18. Chen F, Stuart M (1994) Colonoscopic follow-up of colorectal carcinoma. Dis Colon Rectum 37:568–572. https://www.ncbi.nlm.nih.gov/pubmed/8200236

  19. Leggett BA, Cornwell M, Thomas LR, Buttenshaw RL, Searle J, Young J, Ward M (1997) Characteristics of metachronous colorectal carcinoma occurring despite colonoscopic surveillance. Dis Colon Rectum 40:603–608. https://www.ncbi.nlm.nih.gov/pubmed/9152192

  20. Xiang L, Zhan Q, Zhao XH, Wang YD, An SL, Xu YZ, Li AM, Gong W, Bai Y, Zhi FC, Liu SD (2014) Risk factors associated with missed colorectal flat adenoma: a multicenter retrospective tandem colonoscopy study. World J Gastroenterol 20:10927–10937. https://doi.org/10.3748/wjg.v20.i31.10927

    Article  PubMed  PubMed Central  Google Scholar 

  21. Johnson DA, Barkun AN, Cohen LB, Dominitz JA, Kaltenbach T, Martel M, Robertson DJ, Boland CR, Giardello FM, Lieberman DA, Levin TR, Rex DK, Cancer USM-STFoC (2014) Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology 147:903–992. https://doi.org/10.1053/j.gastro.2014.07.002

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

      Da Hyun Jung

    2. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

      Ja In Lee, Cheal Wung Huh & Byung-Wook Kim

    3. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

      Min Jae Kim & Young Hoon Youn

    4. Chonbuk National University Medical School, Jeonju, Korea

      Yeong Hyeon Choi

    5. Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Gyeonggi-do, Korea

      Cheal Wung Huh

    Authors
    1. Da Hyun Jung
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Ja In Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Cheal Wung Huh
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Min Jae Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Young Hoon Youn
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Yeong Hyeon Choi
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Byung-Wook Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Cheal Wung Huh.

    Ethics declarations

    Disclosures

    Drs Da Hyun Jung, Ja In Lee, Cheal Wung Huh, Min Jae Kim, Young Hoon Youn, Yeong Hyeon Choi, and Byung-Wook Kim have no conflicts of interest or financial ties to disclose.

    Additional information

    Publisher's Note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    Da Hyun Jung and Ja In Lee have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Jung, D.H., Lee, J.I., Huh, C.W. et al. Withdrawal time of 8 minutes is associated with higher adenoma detection rates in surveillance colonoscopy after surgery for colorectal cancer. Surg Endosc 35, 2354–2361 (2021). https://doi.org/10.1007/s00464-020-07653-x

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-020-07653-x

    Keywords

    Search

    Navigation